The Success of Endodontic Therapy - Healing and Function
LOD-089-00
Dr. Shimon Friedman
The Success of Endodontic Therapy - Healing and Function<br>Over 30% of root-filled teeth in the population present with persistent disease, suggesting an extensive need to manage the affected teeth. Treatment options include extraction and replacement, orthograde retreatment and apical surgery, and selection between these can often be complex. When the patient is motivated to retain the affected tooth, a key consideration is the prognosis, or potential for healing; therefore, the prognosis should be communicated to patients in a clear and objective manner. This lecture focuses on the prognosis of orthograde retreatment and apical surgery.<br><br>Inconsistent reports on the prognosis of orthograde retreatment and apical surgery, in contrast with consistently favourable reports for implant-supported single-tooth replacement, have caused considerable confusion in the profession. To reliably reflect the prognosis, studies must conform to design and methodology criteria consistent with an acceptable level of evidence. These criteria are met by only a few studies on retreatment and apical surgery. This lecture identifies the studies that provide the best evidence and outlines the prognosis of retreatment and apical surgery in regards to healing and symptom-free function of the treated teeth. Furthermore, specific clinical factors are highlighted that may influence the prognosis.
Endodontic Rotary Instrumentation - How to achieve maximum efficiency while eliminating failure
LOD-085-00
Dr. John T. McSpadden
There may be more instrumentation technique recommendations than there are endodontic instruments available. Obviously, all cannot be the 'best' approach. Are these techniques confusing motion with accomplishment and time with safety? This presentation describes 6 basic principles that enable the practitioner to maximize endodontic rotary instrumentation in terms of effectiveness, efficiency and safety for any type endodontic file available today and as they become available in the future. Saving valuable time and eliminating pernicious stress are the result.
The use of MTA in Clinical and Surgical Endodontics
LOD-082-00
Dr. Arnaldo Castellucci
Recently, Dr. Mahmoud Torabinejad of Loma Linda University, California, has developed a new cement named Mineral Trioxide Aggregate which appears to have all of the characteristics requested of the ideal cement to seal pathways of communications between the pulp and the oral cavity (mechanical and carious pulp exposures), and between the root canal system and the periodontium (iatrogenic perforations, open apices, resorbed apices, root-end preparations).<br><br>MTA is an endodontic cement that is extremely biocompatible, capable of stimulating healing and osteogenesis, and is hydrophilic. MTA is a powder that consists of fine trioxides (Tricalcium oxide, Silicate oxide, Bismute oxide) and other hydrophilic particles (Tricalcium silicate, Tricalcium aluminate, responsible for the chemical and physical properties of this aggregate), which set in the presence of moisture. Hydration of the powder results in formation of a colloidal gel with a pH of 12.5, that solidifies to a hard solid structure in approximately three-four hours. This cement is different from other materials currently in use because of its biocompatibility, antibacterial properties, marginal adaptation and sealing properties, and its hydrophilic nature.<br><br>The characteristic that distinguishes MTA from other materials used to date in endodontics is its hydrophilic properties. Materials used to repair perforations, to seal the retro-preparation in surgical endodontics, to close open apices, or to protect the pulp in direct pulp capping, are inevitably in contact with blood and other tissue fluids. Moisture may be an important factor due to its potential effects on the physical properties and sealing ability of the restorative materials. As shown by Torabinejad et al., MTA is the only material that is not affected by moisture or blood contamination: the presence or absence or blood seems not to affect the sealing ability of the mineral trioxide aggregate.<br><br>During the presentation, several cases of treatment with MTA will be showed. Aim of the presentation is to show the indications and the technique for the correct use of this relatively new material: how to seal an open apex, how to repair a strip-perforation under the microscope, how to protect a pulp exposure to perform a direct pulp capping, how to use MTA during surgery to seal the retroprep.<br><br>In conclusion, the viewers should be able to appreciate the advantages of this material, which made our treatments more predictable and gave us the possibility to save teeth otherwise condemned to extraction.
Aspectos Biologicos em Implantes Unitarios (PORTUGUESE LANGUAGE ONLY)
LOD-073-00p
Dr. Mario Groisman
Aspectos Biologicos em Implantes Unitarios (PORTUGUESE LANGUAGE ONLY)
Clinical Pharmacology - What Every Dentist Should Know
LOD-072-00
Dr. Anthony Feck
Modern dentistry has expanded the arsenal of services to restore patients oral health and cosmetic needs like never before. These changes have corresponded to an increasingly complex medical environment where patients are presenting at a more advanced age, with more medical conditions, and taking more medications. Understanding the pharmacology as it relates to their systems and how the drugs they are taking, as well as those we intend to administer affect the patient, one another, and our planned treatment is necessary for a safe and successful outcome to our planned care.
Treating the Medically Complex Patient
LOD-069-00
Dr. Adi Garfunkel
• What is the dental-medical approach to the hypertensive patient?<br> • Could we treat patients with medication induced bleeding tendency?<br> • The use of adrenalin in local anesthesia constitutes at times a contradictory subject. How do we deal with this question?<br>
YSGG Laser Precision in Periodontal Plastic Surgery
LOD-059-00
Dr. Bobby Butler
Lasers have been used in dentistry for many years. Mostly they have been used with soft tissue procedures. Recently the Er,Cr:YSGG laser has been shown to be safe and effective in osseous procedures. Many cosmetic dentists have been using lasers for esthetic crown lengthening procedures, but most of these cases are simple gingivectomies and not true crown lengthening procedures. Complications can occur without understanding the biologic width and different periodontal biotypes. This presentation will discuss current and future applications with the Er, Cr: YSGG laser with periodontal surgical procedures. The focus will be its use in closed and open esthetic crown lenghtening procedures. Discussion with case selection and osseous biotypes with be stressed. Other applications involving osseous augmentation procedures, harvesting osseous blocks, ridge splitting and lateral sinus wall procedures, will also be briefly discussed.
Bone Morphogenetic Proteins, A Realistic Alternative to Bone Grafting<br>
LOD-054-00
Dr. Ulf Wikesjo
Surgical placement of oral implants is governed by the prosthetic design and by the morphology and quality of the alveolar bone. Often, implant placement may be difficult, if at all possible, due to alveolar ridge aberrations. In consequence, prostheticly dictated implant positioning commonly entails bone augmentation procedures. One objective of our laboratory is to evaluate the biologic and clinical potential of bone morphogenetic proteins (BMPs) including rhBMP-2, rhOP-1/rhBMP-7, rhGDF-5, other candidate biologics, bone biomaterials, and devices for alveolar ridge augmentation and implant fixation. This presentation will discuss the unique biologic potential, the clinical relevance and perspectives of BMP technologies for alveolar bone augmentation and oral implant fixation, in particular the development of a unique bone-inductive oral implant. This presentation will also address merits and explain short-comings of current treatment protocol including bone biomaterials and guided bone regeneration (GBR). BMPs have an unparalleled potential to augment alveolar bone and support implant osseointegration and long-term functional loading. Inclusion of BMPs for alveolar augmentation and osseointegration will not only enhance predictability of existing clinical protocol but radically change current treatment paradigms. Inclusion of the bone-inductive oral implant in the treatment panorama may make 'grafting' and GBR procedures altogether obsolete.
Endodontic Access and Negotiation - Breaking & Entering
LOD-038-00
Dr. L. Stephen Buchanan
Technological advances in shaping and filling root canal systems have resulted in extremely consistent and ideal outcomes making those procedures more science than art form. However, cutting access cavities, finding all the canals in a tooth, and negotiating them to their full apical extents still requires developed skills and careful attention to detail. Ironically, many clinicians consider the access preparation and root canal negotiation those things we do to get to the important stuff afterwards this is ironic because when a mistake occurs during these initial phases in treatment it is often impossible to recover. Loss of structural integrity, perforations, missed canals, blocked canals, ledged canals and broken files are just some of the negative outcomes that occur when access and negotiation procedures go awry.<br><br>With adequate radiographs, the right access instruments, ultrasonic handpieces, lubricants, apex locators, and a predictable negotiating technique, artful outcomes can and should be the expected result when we head into a root canal space. Dr. Buchanan will show, in a step-by-step manner, the concepts, instruments, and techniques needed to set the stage for endodontic success using CT reconstructions of endodontic anatomy, video footage shot through an operating microscope, and radiographs of clinical cases.
Endo or Implant - Rational decision making from an Endodontist's viewpoint
LOD-029-00
Dr. L. Stephen Buchanan
As an Endodontists who places implants, Dr. Buchanan presents a uniquely balanced argument for when to save teeth with endodontic therapy and when the patient will be better served by replacement of the tooth with an implant. Dr. Buchanan will first explain the procedural advances available from endodontic specialists to save many teeth previously thought to be unsalvageable, including microsurgery, MTA root repair material, ultrasonics, and state-of-the-art shaping, cleaning, and 3D obturation technology. Then he will discuss how the structural integrity of roots greatly affects the long term prognosis of endodontically-treated teeth and methods for maintaining the inherent strength of teeth being saved with RCT. Finally, Dr. Buchanan will explore the advantages and satisfaction of a multi-disciplinary approach to treatment planning with an emphasis on the new trend of endodontists to view themselves as understructure specialists.